Citing long waiting lists for veterans and lack of Veterans Administration facilities in many areas, Kentucky senator and GOP presidential candidate Rand Paul called Monday for the struggling agency to only focus on certain surgical procedures while using vouchers to help patients pay for routine visits and tests at non-government facilities.

Paul’s comments came during a Mount Pleasant forum hosted by the Concerned Veterans for America nonprofit. The senator, who is an ophthalmologist in his private life, said the high demand for treatment is “rationed” through long waiting lists under the single-payer military health insurance system.

“It’s not very efficient and never will be,” Paul told about 300 people in attendance at the Omar Shrine Temple “If we decide we want VA hospitals, let’s keep them for some of the specialized things: for burns, unfortunately for amputations, post-traumatic stress disorder, and some veterans’ needs. But I think for routine care, if you live an hour and a half from the VA and… need a routine colonoscopy, you ought to just be able to get it in your local town.”

He made the comments while talking about issues with the government’s new “Choice Cards.” Congress required the cards after a public outcry over cover-ups on lengthy appointment backlogs at VA clinics. The cards allow a veteran to go outside the VA network for private care if they meet several conditions: including living more than 40 miles from a VA clinic or having a greater than 30-day wait for their care.

But Paul said he does not believe the cards go far enough.

“I’m not saying eliminate what we have,” he said. “I’d say keep some specialty hospitals. But I’d also have the transition, see if we can save some money and help with the convenience of veterans and let them have a choice to go into private care.”

The VA is asking Congress for permission to shift its funding on the cards, arguing it needs to fix a $3 billion hole in other sections of its budget. The Military Times reports VA Secretary Bob McDonald warned a House committee last week that his department will begin closing clinics, canceling private-care appointments and furloughing staff if new funding is not freed up by August 1. But some members of the committee were unhappy that the VA did not alert them to the looming budget problems earlier in the year.

Paul also used Monday’s forum to defend his more isolationist position than most of his fellow GOP challengers. He blamed then-Secretary of State Hillary Clinton for U.S. intervention in Libya that he said was “a mistake from start to finish” which destabilized the country and allowed fundamentalist Muslims to gain more control in a “failed state.”

“I think we go to war when we have to defend ourselves and our interests. We should defend our embassies. It’s the biggest fault I have for Hillary Clinton is she didn’t defend Benghazi and it should forever preclude her from being Commander-in-Chief.”

He was also hesitant to support “boots on the ground” fighting against ISIS in Iraq and Syria. He also questioned which “moderates” the U.S. planned to arm against Islamic extremists, arguing that some of those same groups have connections to al Qaeda. “You’ve got to figure out which one’s our enemy and which ones are our friends,” he said to applause. “I have a proposal: why don’t we quit sending foreign aid to people who hate us?”